Commentary: defining and understanding adolescent romantic competence: progress, challenges, and implications.

Commentary on the articles in this special section is provided. Following a brief review of the articles in this section, discussion focuses on the conceptualization of adolescent romantic competence, the importance of studying competence, and the implications of research in this area for knowing how to help young people have more successful romantic relationships.     

The enigmatic inflammatory pseudotumours: the current state of our understanding, or misunderstanding

The inflammatory pseudotumour is a bona fide tumour in the sense of a mass lesion, which is known to present in virtually every anatomic region and organ from the central nervous system to the gastrointestinal tract. A fundamental question about pathogenesis is whether the inflammatory pseudotumour is a pseudo-or true neoplasm. There is evidence to support the argument that some of these fibroinflammatory masses are infection-associated and are often characterized by a proliferation of spindled histiocytes and/or dendritic cells, in contrast to a myofibroblastic proliferation in the other inflammatory pseudotumour, also known as the inflammatory myofibroblastic tumour.     

Expression profiling technology: its contribution to our understanding of breast cancer

Breast cancer is a complex genetic disease characterized by the accumulation of multiple molecular alterations. Routine clinical management of breast cancer relies on clinical and pathological factors, however. These seem insufficient to reflect the whole clinical heterogeneity of tumours and are less than perfectly adapted to each patient. Recent advances in human genome research and high-throughput molecular technologies have made it possible to tackle the molecular complexity of breast cancer and have contributed to the realization that the biological heterogeneity of breast cancer has implications for treatment. Gene expression profiling of breast cancer has been performed using several approaches. This review will describe the details of gene expression profiling of breast cancer, the different approaches and the impact on clinical management.     

Troy D. Zars: a personal tribute to a scientist,colleague, and friend

Abstract

I knew Troy for nearly 15?years, and in that time I don’t recall hearing any childhood stories like those in seemingly every personal statement I’ve read from aspiring scientists or medical students. No stories about hours spent gazing at an anthill. I don’t recall hearing about shelves crowded with insects collected on Styrofoam, or animal skulls kept in a shoebox under his bed. If these collected crania existed, it was more likely because Troy was a crack shot with a pellet gun than a need to know adaptations in the dentition of local squirrel populations. I don’t recall hearing about science projects taken to the Iowa State Capitol to share with politely interested legislators. But I do recall hearing about spending the entirety of the daylight hours in the summer, with his brother Doug, finding where the crappie were biting. About crystal clear water on a lake in Minnesota that you didn’t quite need to know the exact location of, just in case you were thinking of going and plundering the walleye within. I definitely heard about triumphs as a starting lineman not only for his high school football team, but the mighty Norse of Luther College. I heard about summer warehouse jobs in sweltering Iowa Julys. And I saw, firsthand, love and commitment and family. Troy’s story demonstrates that the finest scientists are not just cultivated in narrow STEM curricula that begin at age 5. They are just as likely to be football-playing fishermen, fathers, husbands, and friends who can navigate an operant conditioning paradigm during the week, and dance a polka and produce a magnificent smoked pork shoulder on Saturday. Nature and an independent spirit and a little bit of mischief is a different kind of Magnet school. And it gave us truly one of the best.     

Extending our understanding of burnout: test of an integrated model in nonservice occupations

C. L. Cordes and T. M. Dougherty (1993) provided a conceptual framework of job burnout in nonservice organizations. This study sought to determine the "fit" of that theoretical model within nonservice occupations. LISREL VIII was used to test this model on 165 participants, and the overall model fit the data well. Supervisory support moderated the relationships between the role conflict, role ambiguity, and quantitative role overload stressors and emotional exhaustion and between emotional exhaustion and depersonalization. Unexpectedly, role conflict, role ambiguity, and quantitative role overload had a positive impact on emotional exhaustion when supervisory support was high. As expected, participation had a negative association with depersonalization. Employees experiencing emotional exhaustion were more likely to feel nervous or tense at work.     

Amplification or obfuscation: is localization improving our clinical understanding of phosphorus metabolism?

Localization techniques are considered an indispensable part of the clinical spectroscopy examination. The results are often a marked improvement in diagnostic information (amplification), but because of the introduction of new artifacts and the more prolonged examination time, some of the undoubted advantage is lost (obfuscation). There is thus an argument for continued development of more rapid methods of clinical spectroscopy and, if necessary, sacrificing some spatial information.     

Lessons from osteopetrotic mutations in animals: impact on our current understanding of osteoclast biology

Throughout life, bone tissue is in a constant state of turnover. This process of bone remodeling is the result of a combination of sequential removal of bone tissue by osteoclasts and new bone deposition by osteoblasts. The osteopetroses are a heterogeneous group of skeletal disorders characterized by a generalized increase in bone mass caused by decreased bone resorption. Over the past decade, major contributions to our current knowledge on bone resorption have been made by studies of osteopetrotic mutations in animals. A considerable heterogeneity among the various osteopetrotic animals is observed, showing that a multiplicity of mutations may cause osteopetrosis. This review focuses on the spontaneous and experimentally induced osteopetrotic mutations in animals. We will discuss their impact on our current understanding of osteoclast biology and we will correlate, when possible, the animal models of osteopetroses to diseases in humans.     

Use of laser capture microdissection, cDNA microarrays, and tissue microarrays in advancing our understanding of prostate cancer

One difficulty in studying epithelial tumors has been the inability to isolate pure samples for DNA and RNA analysis. Prostate cancer, with its infiltrative nature, is particularly challenging. The Combination of several new technologies should help overcome these hurdles. Laser capture microdissection uses a laser beam to achieve transfer of pure cell populations for isolation of DNA, RNA, and protein. High-throughput analysis of these samples can be achieved by using cDNA expression microarrays. High-density tissue microarrays should allow for validation of differentially expressed genes. This review will concentrate on the application of laser capture microdissection, cDNA microarrays, and tissue microarrays in the area of prostate cancer research.     

1987 H. P. Smith award lecture. Eyes for the epidemiologist: the pathologist's role in shaping our understanding of the asbestos-associated diseases

Asbestosis was first recognized as an entity at autopsy by a pathologist in 1900. Pathologists also discovered the unique relationship of mesothelioma and bronchogenic carcinoma with exposure to asbestos. The observations of preceding pathologists have provided insights that have served as the basis for epidemiologic studies associating asbestos with disease in humans.     

The anococcygeal ligaments: Cadaveric study with application to our understanding of incontinence in the elderly

The term “anococcygeal ligament (ACL)” has been used to refer to two distinct structures: a superficial fibrous band originating from the myosepta of the external anal sphincter (EAS) and running upwards to the coccyx (the superficial ACL); and a deep fibrous band originating from the periosteum of the coccyx, merging with the thick presacral fascia and attaching to the superior end of the EAS (the deep ACL). In the present work, elastic fiber histology and muscle immunohistochemistry of sagittal sections obtained from 15 donated elderly male cadavers showed that superficial ACL, corresponding to a superficial fascia or skin ligament, was composed of very tortuous elastic fibers, with a fine elastic fiber mesh at their coccygeal attachment; whereas the deep ACL was composed of almost straight collagen and elastic fibers, intermingled with the coccygeal periosteum. Due to the weak insertion into the coccyx and the wavy course, the superficial ACL is unlikely to provide, even in association with contraction of the longitudinal anal muscle, a stable mechanical support to maintain the configuration of the EAS. Being similar to the suspensory ligament of breast, tissue repair of the skin ligament would not have a mechanical role. In contrast, the deep ACL, in association with the thick presacral fascia, likely plays a role in maintaining a suitable positioning of the anorectum to the coccyx. However, their relative lack of smooth muscles compared with rich elastic fibers indicates that both ACLs may become permanently overextended under conditions of long‐term mechanical stress. Clin. Anat. 28:1039–1047, 2015. © 2015 Wiley Periodicals, Inc.     

Cultural competence and medical education: many names, many perspectives, one goal.

Two contemporary reports from the Institute of Medicine--Crossing the Quality Chasm and Unequal Treatment--highlighted the importance of patient-centered care and cultural competence training as a means of improving the quality of health care for all and eliminating racial/ethnic disparities in health care. Previous efforts in cultural competence have aimed to teach about the attitudes, values, beliefs, and behavior of certain groups. A more effective approach is to learn a practical framework to guide inquiry with individual patients about how social, cultural, or economic factors influence their health values, beliefs, and behaviors. Rather than learning about individual cultures and their characteristics, this approach focuses on the issues that arise most commonly due to cultural differences, and how they may affect a physician's interaction with any patient. At the end of the day, physicians need a practical set of tools and skills that will enable them to provide quality care to patients everywhere, from anywhere, with whatever differences in background that may exist, in what is likely to be a brief clinical encounter. Call it what you will, the field of cultural competence aims quite simply to assure that health care providers are prepared to provide quality care to diverse populations.     

Children's appraisals of maternal involvement in coping with diabetes: enhancing our understanding of adherence, metabolic control, and quality of life across adolescence

OBJECTIVE: To examine how children's appraisals of maternal involvement in coping with diabetes are associated with adherence, metabolic control, and quality of life across adolescence. METHODS: Children (N = 127, ages 10-15 years) with type 1 diabetes completed measures of adherence, quality of life, and appraisals of mothers' involvement in dealing with diabetes problems (i.e., mother appraised as uninvolved, controlling, or collaborative). Metabolic control was indexed through medical records. RESULTS: Regardless of age or sex of child, appraised maternal uninvolvement was associated with poorer adherence and quality of life, while appraised collaboration was associated with better adherence and metabolic control. There was evidence that the association between appraised collaboration and metabolic control was partially mediated by adherence. Appraised control was associated with poorer adherence among older, but not younger, children and with poorer quality of life among older females but not among older males or younger children of either sex. CONCLUSIONS: Maintaining maternal involvement in diabetes care is important across ages 10 to 15, but the optimal form of this involvement may need to be adjusted to be consistent with the child's level of development. The present findings suggest that better adherence is seen across age when mothers are viewed as collaborating with, as opposed to controlling, their child when dealing with diabetes problems.     

Measures of cultural competence: examining hidden assumptions.

PURPOSE: The authors critically examined the quantitative measures of cultural competence most commonly used in medicine and in the health professions, to identify underlying assumptions about what constitutes competent practice across social and cultural diversity. METHOD: A systematic review of approximately 20 years of literature listed in PubMed, the Cumulative Index of Nursing and Allied Health Literature, Social Services Abstracts, and the Educational Resources Information Center identified the most frequently used cultural competence measures, which were then thematically analyzed following a structured analytic guide. RESULTS: Fifty-four instruments were identified; the 10 most widely used were analyzed closely, identifying six prominent assumptions embedded in the measures. In general, these instruments equate culture with ethnicity and race and conceptualize culture as an attribute possessed by the ethnic or racialized Other. Cultural incompetence is presumed to arise from a lack of exposure to and knowledge of the Other, and also from individual biases, prejudices, and acts of discrimination. Many instruments assume that practitioners are white and Western and that greater confidence and comfort among practitioners signify increased cultural competence. CONCLUSIONS: Existing measures embed highly problematic assumptions about what constitutes cultural competence. They ignore the power relations of social inequality and assume that individual knowledge and self-confidence are sufficient for change. Developing measures that assess cultural humility and/or assess actual practice are needed if educators in the health professions and health professionals are to move forward in efforts to understand, teach, practice, and evaluate cultural competence.